Robotic total endoscopic double-vessel coronary artery bypass grafting¡ªstate of procedure development

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• 作者：Johannes Bonatti ; MD ; FETCS^a ; ^{johannesbonatti@gmail.com} ; Eric J. Lehr ; MD ; PhD ; FRCSC^a ; Thomas Schachner ; MD^b ; Dominik Wiedemann ; MD^b ; Felix Weidinger ; MD^b ; Brody Wehman ; MD^a ; Andreas R. de Biasi ; MD^a ; Nikolaos Bonaros ; MD ; PhD ; FETCS^b ; Bartley Griffith ; MD^a
• 关键词：CABG ; coronary artery bypass grafting ; ITA ; internal thoracic artery ; TECAB ; total endoscopic coronary artery bypass grafting
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：144
• 期：5
• 页码：1061-1066
• 全文大小：229 K

文摘

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Objective

Robotic total endoscopic coronary artery bypass grafting (TECAB) has been under development for 10 years. With increasing experience and technological improvement, double-vessel TECAB has become feasible. The aim of the present study was to compare the current outcomes of single- and double-vessel TECAB.

Methods

Between 2001 and 2011, 484 patients underwent TECAB by 4 surgeons at 2 institutions. The median patient age was 60 years (range, 31-90), and the median European System for Cardiac Operative Risk Evaluation was 2 (range, 0-13). Single-vessel (n?=?334) and double-vessel (n?=?150) procedures were performed using the da Vinci, da Vinci S, and da Vinci Si robotic systems.

Results

Compared with the single-vessel procedure, double-vessel TECAB required a longer operative time (median, 375 minutes; range, 168-795; vs median, 240; range, 112-605; P?<?.001) and had an increased conversion rate to a larger thoracic incision (31/150 [20.7 % ] vs 31/334 [9.3 % ]; P?<?.001). The median ventilation time was 10 hours (range, 0-288) for double-vessel versus 8 hours (range, 0-278) for single-vessel procedures (P?=?.006). The hospital stay was comparable, with 6?days (range, 2-27) for double-vessel TECAB and 6 days (range, 2-33) for single-vessel TECAB (P?=?.794). Perioperative mortality was 0.3 % (1/334) with single-vessel TECAB and 2.0 % (3/150) with double-vessel TECAB (P?=?.090). Freedom from major adverse cardiac and cerebral events at 5 years was similar after double- and single-vessel TECAB (73.5 % vs 83.1 % , P?=?.150). The 5-year survival was 95.8 % and 93.9 % (P?=?.708).

Conclusions

Double-vessel TECAB appears feasible and reproducible. The operative times were longer and the conversion rates to a larger thoracic incision were greater than with single-vessel TECAB. Also, the postoperative ventilation time was longer. Other perioperative morbidity and mortality and the recovery time and long-term clinical outcomes, however, were comparable.